NYSDA News May 2023

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Putting Smiles on Kids’ Faces

NYSDA Expands Outreach

NYSDA has extended its outreach to children without ready access to dental care with the addition of Marlyce James, M.Ed., R.D.H., CDA, who has been contracted by NYSDA through the Association’s Dental Demonstration Project.

Ms. James, who is studying to become a community dental health coordinator, is a professor at the State University of New York Erie Community College, where she is the department head of the School of Dental Hygiene. She is also a dental hygiene consultant and graduate assistant at D’Youville University in Buffalo as she completes her doctoral degree in Health Professions Education. She was recently appointed dental hygienist liaison for New York State through a collaboration with the American Dental Hygienists’ Association and the National Center for Health, Behavioral Health, and Safety.

She will be working on outreach as follow-up to the Suffolk County Dental Society Give Kids A Smile event on April 29, connecting children seen at the event to dental health homes. Additionally, Ms. James will lead a project with Head Start, providing screening, referral and education to improve health literacy


the importance of preventative care.

AN OFFICIAL PUBLICATION OF THE NEW YORK STATE DENTAL ASSOCIATION NEWS MAY 2023 Volume 36 • Issue 2 The Sleep and Bone Connection University at Buffalo researchers believe they may have found a connection between obstructive sleep apnea and weaker bones and teeth in adults 4 Just as Effective as Sealants? If NYU researchers are right, silver diamine fluoride is an effective—and more practical—weapon against childhood caries than dental sealants 8 How Growing Pumpkins Can Make You a Better Dentist There are lessons to be learned about yourself and your profession when immersed in backyard horticulture… 9
among and impressing upon them Marlyce James Betsy Bray, R.D.H., NYSDA Director Health Affairs and Dental Demonstration Project Director, meets up with Marlyce James at GKAS event. More than 130 volunteers from Suffolk County delivered donated dental care to nearly 200 children. Tooth Fairy Arielle Melendez makes appearance at Give Kids A Smile event April 29, hosted by Suffolk County Dental Society at Long Island Aquarium. Ms. Melendez, a second-year dental student at Touro College Dental Medicine, is with Marlyce James, registered dental hygienist and certified dental assistant, who is following up with children seen at the event to direct them to dental health homes.

New Federal Mandate (MATE) takes effect June


What dentists need to know

THE MEDICATION ACCESS AND TRAINING EXPANSION (MATE) Act, passed by Congress as part of the Omnibus Bill of 2022, mandates most practitioners licensed to prescribe controlled substances, including dentists, complete eight hours of one-time training on safely prescribing controlled substances (Schedules II, III, IV, and/or V) in order to receive or renew their registration with the U.S. Drug Enforcement Administration (DEA).





Mary Grates Stoll


Jeanne DeGuire


Ed Stevens


James E. Galati, President

Anthony M. Cuomo, Vice President

Prabha Krishnan, Vice President

Frank C. Barnashuk, Secretary-Treasurer

Steven Gounardes, Speaker of the House

Gregory D. Hill, Executive Director

Editorial and advertising offices are at Suite 602, 20 Corporate Woods Boulevard, Albany, NY 12211-2370.

Telephone (518) 465-0044. Fax (518) 465-3219. Email info@nysdental.org. Website www.nysdental.org.

MAY 2023

Volume 36 • Issue 2

The NYSDA News (ISSN 1531684X) is published quarterly, in February, May, October and December, by the New York State Dental Association, Suite 602, 20 Corporate Woods Boulevard, Albany, NY 12211-2370. It is available in digital form only and accessible online in the members-only section of the NYSDA website, www.nysdental.org, under publications.


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Obstructive Sleep Apnea Tied to Weaker

Bones and Teeth in Adults

Obstructive sleep apnea may be linked to low bone mineral density in adults, according to University at Buffalo-led research.

The findings are crucial for individuals with sleep apnea, as low bone mineral density is an indicator of osteoporosis. In addition to increasing the risk of fractures, low bone mineral density also impacts oral health, causing teeth to become loose and dental implants to fail, says senior author Thikriat Al-Jewair, D.D.S., associate professor of orthodontics in the UB School of Dental Medicine and director of the school’s Advanced Education Program in Orthodontics.

The study was published in November in The Journal of Craniomandibular and Sleep Practice. The researchers used cone beam computed tomography (CBCT) to measure bone density in the head and neck of 38 adult participants, half of whom had obstructive sleep apnea.

When controlling for age, sex and weight, the participants with obstructive sleep apnea had significantly lower bone mineral density than the participants without the condition.

Obstructive sleep apnea can cause hypoxia, inflammation, oxidative stress and shortened breathing patterns. Each of these symptoms may have a chronic negative effect on bone metabolism and, ultimately, bone density, says Dr. Al-Jewair.

“While the link between obstructive sleep apnea and low bone mineral density has yet to be fully explored, this study offers new evidence on their connection that could have several implications for orthodontic treatment,” says Dr. Al-Jewair, also assistant dean for equity, diversity and inclusion in the UB School of Dental Medicine.

“If a patient has been diagnosed with sleep apnea, this can influence treatment planning and management. CBCT imaging has become an integral part of daily orthodontic practice and could be used as a screening tool for low bone mineral density,” she said. “Orthodontists could then inform their patients of their propensity for low bone mineral density and encourage them to seek further consultation with their physician, as well as warn the patient of possible adverse outcomes, increased risks and effects on treatment time.”

Future research with larger sample sizes is needed, says Dr. Al-Jewair.

Additional investigators include first author Mira Daljeet, D.M.D., former resident in the UB Department of Orthodontics; David Covell, D.D.S., Ph.D., professor and L.B. Badgero Endowed Chair of the UB Department of Orthodontics; Stephen Warunek, D.D.S., UB clinical assistant professor of orthodontics; Alberto Monegro, M.D., attending physician in the Jacobs School of Medicine and Biomedical Sciences at UB; and Terry Giangreco, D.D.S.. z


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Touro Student is National Presenter

RACHEL SEBASTIAN, third-year student, Touro College of Dental Medicine, traveled to Portland, OR, in March to deliver oral poster presentation at annual meeting of American Association for Dental, Oral and Craniofacial Research/Canadian Association of Dental Research. Her presentation, “Factors Affecting Early Implant Failure Following a Fully Guided Surgical Protocol,” was delivered as part of the conference’s Student Competition for Advancing Dental Research and its Application. Ms. Sebastian was previously awarded first place at the 2022 TCDM Research Day Student Poster Competition. z

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School Dental Program Prevents 80

Percent of Cavities with One-Time, Non-Invasive Treatment

Silver diamine fluoride, as well as sealants, protected against cavities in school-based program.

In a study of nearly 3,000 schoolchildren, conducted by researchers at NYU College of Dentistry, silver diamine fluoride was found to be as effective against cavities as dental sealants, the standard of care. A single dose of either topical treatment given in elemen tary schools prevented roughly 80% of cavities and kept 50% of cavities from worsening when children were seen two years later.

The findings, published in JAMA Network Open, offer an efficient and cost-effective approach to improving children’s oral health through school-based care.

While dental cavities are the most common chronic disease in children, and kids from low-income families are twice as likely to have cavities as those from higher-income families, getting kids to a dentist for the recommended twice-yearly visits can be challenging, especially when parents need to take time off of work. To reduce the barri ers to seeing a dentist, some basic dental services can be offered in schools, especially those serving children from low-income families. For example, the Centers for Disease Control and Prevention recommends and funds school sealant programs. In 2017, NYU College of Dentistry researchers received funding from the Patient-Centered Outcomes Research Institute (PCORI) to run the nation’s largest school-based cavity prevention study, which they named CariedAway.

CariedAway is a randomized trial comparing the effectiveness of two cavity-prevention techniques: a “simple” treatment using silver diamine fluoride (SDF) and fluoride varnish, and a “complex” treatment using traditional glass ionomer sealants and fluoride varnish. Both are non-invasive and applied to the surface of teeth to prevent and arrest cavities in children, but for the same time and cost, providers can treat more children with the simpler, SDF therapy.

The study included 2,998 children in kindergarten through third grade at 47 New York City schools. The schools—which serve a racially diverse group of students, most of whom are from low-income families—were randomized to receive either the simple or complex treatment.

Upon visiting each school, the clinical research team—which included a supervising dentist, dental hygienists, registered nurses and assistants—did baseline exams to measure any tooth decay, and then applied fluoride varnish and either sealants or SDF, depending on whether the school was assigned to receive the complex or simple treatment.

The initial visits took place in 2019 and early 2020, and were paused when the COVID-19 pandemic temporarily closed New York City schools and halted all school-based care. Two years later, schools allowed the clinical research team to resume visits, and they returned to each school for follow-up visits.

The researchers found that both the simple and complex treatments were successful: just one cavity-prevention treatment prevented more than 80% of cavities (81% for SDF and 82% for sealants) and


Giant Pumpkins and a Life Lesson

It’s all about finding excitement in what you do and sharing that enthusiasm with others.

THE MINNESOTA STATE FAIR is a magical place. For 12 days each year, the state fairgrounds come alive with food vendors, carnival rides and over 900 live performances. While eating fried cheese curds served by the bucket, patrons can take in live butter sculpting, livestock competitions and more. With this litany of entertain-


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Lawsuit Settlement Paves Way for Improved Dental Care of Medicaid Patients

Changes to dental benefit program also expected to result in cost savings to taxpayers

A FEDERAL CLASS-ACTION LAWSUIT brought against the New York State Department of Health (NYSDOH) on behalf of Medicaid recipients in New York who were denied coverage for medically necessary dental care was settled May 1 in favor of the recipients. The decision in the suit, which was originally brought in 2018, brings to an end the strict limit that denied coverage for crowns and root canals to individuals with more than four pairs of teeth, an archaic policy not aligned with modern United States dental practice. Coverage for those procedures will now be approved for Medicaid recipients when deemed medically necessary, including for balance and function.

The expected changes to the Medicaid dental benefit program will mean added coverage for approximately five million New Yorkers with Medicaid coverage statewide for routine dental care and procedures to help these patients maintain better oral and overall health. The settlement will go into effect 90 days after the court’s approval.

NYSDA has made known its support for the expanded coverage, noting in a public release that dental health plays a vital role in overall health and emphasizing that the Association is committed to advocating for the prioritization of access and expanded coverage for medically necessary procedures that significantly benefit the patient’s well-being.

While NYSDA supports equitable care for all New Yorkers, it remains cautious about challenges that continue to exist that impact access to care for Medicaid populations, among them, an approval process for Medicaid that is at times arduous due to a complex preauthorization system, and provider panels for some dental specialists that are extremely limited. It reminds its members and the public that it has consistently advocated for easing the administrative burden on dentists to provide this care, and has worked tirelessly to prevent reimbursement decreases and to increase the Medicaid reimbursement rates.

In her Executive Budget, Gov. Kathy Hochul included strategic investments for programs that the state’s most vulnerable residents utilize, including increased reimbursement rates for dental services to ensure access for all


New York State Department of Health Announces Open Positions with State’s Pioneering Public Health Corps

The New York State Department of Health is continuing efforts to recruit fellows into the New York State Public Health Corps (NYSPHC), a first-in-the-nation program created to strengthen local and statewide workforce capacities to better respond to future public health emergencies. The NYSPHC was established in 2021 in response to the emergent needs presented by the COVID-19 pandemic.

NYSPHC fellows work on a variety of public health projects, including support for the state’s continuing COVID-19 response and recovery, and other work that reinforces the state’s preparedness for future public health emergencies, like those experienced during the recent mpox outbreak and polio response. The program also enables fellows to build connections, educate on key strategies and effectively communicate with New Yorkers during public health emergencies.

The NYSPHC has now identified more than 500 open fellow positions across the state, with many local health departments actively recruiting or preparing to recruit NYSPHC Fellows. The NYSPHC Program is an excellent opportunity for college and advanced degree graduates interested in public health


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NEWS 11 1
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New Federal Mandate continued from page 2 -

At the time of your next scheduled DEA registration submission (prior to June 27, 2023):

• Complete eight hours of qualified training on safe controlled substance prescribing.

• Check a box on your registration submission affirming that you have completed required training.

• Retain copies of all certificates of completion.

Q. Will training credits accepted for state-required opioid training count toward the new federal requirement?

A. Yes. Training hours accepted for state-required opioid training may be used to satisfy the DEA training requirement. Sec. 1263 specifically states: “Nothing in this subsection shall be construed…to preclude the use…of training…to satisfy registration requirements of a State or for some other lawful purpose.”

Q. Will training credits accepted for the Federal DEA eight-hour course count toward the New York State three-hour opioid course requirement?

A. The New York State three-hour opioid course mandates that eight specific topics be covered. Whether the Federal DEA course, or any part of it, counts toward the New York State course depends on the topics the DEA course covers. Check carefully because New York requires that all of the following topics be covered:

• New York State and federal requirements for prescribing controlled substances;

• Pain management;

• Appropriate prescribing;

• Managing acute pain;

• Palliative medicine;

• Prevention, screening and signs of addiction;

• Responses to abuse and addiction; and

• End-of-life care.

Prescribers must complete coursework or training in all eight topic areas, including New York State requirements for prescribing controlled substances. The topics may be covered by a single, comprehensive presentation or by multiple, individual presentations for a total of at least three hours. Hours for accredited coursework or training that meet any of the eight required topics, completed as part of an accredited continuing education program, may be counted toward the requirement. Prescribers must complete the coursework within one year of DEA registration and once every three years after the first attestation.


Upon completion of all required eight training topic areas, the prescriber must attest online via the Narcotic Education Attestation Tracker (NEAT) application in the Health Commerce System (HCS).


Review a comprehensive list of frequently asked questions, such as “Do I have to use a specific CE provider?” “Will ADA CERP credits count?” and more at: http://www.health.ny.gov/professionals/narcotic/mandatory_ prescriber_education/Frequently Asked Questions.


If you have further questions about this federal mandate, the ADA’s Member Service Center is best equipped to answer them. Contact the MSC via e-mail at msc@ada.org, or call (312) 440-2500. Staff are available Monday through Friday from 8 a.m.-5 p.m. Central Time.


If you have further questions about the state mandate, NYSDA is available to assist. Contact NYSDA at info@nysdental.org, or call (518) 465-0044. Staff are available Monday through Friday from 8:30 a.m. – 4:30 p.m. z

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School Dental Program

stopped half of cavities from progressing (56% for SDF and 46% for sealants).

“Without prevention, dental cavities grow continuously if not treated. One CariedAway cavity-prevention treatment, provided just before schools closed during the pandemic, was remarkably effective over the following two-year period,” said Richard Niederman, D.M.D., professor in the Department of Epidemiology & Health Promotion at the College of Dentistry, co-principal investigator of CariedAway, and the study’s senior author. “I know of no other dental preventive intervention that had this great a beneficial impact across the pandemic.”

While the limited availability of trained dental professionals can pose challenges for school sealant programs, as sealants are applied by a dentist or dental hygienist, SDF may be an attractive alternative, because it can also be applied by nurses—a workforce already in place in many schools.

“Our results support the use of SDF for cavity prevention in school-based oral health programs and offer an opportunity for expanding access to critical oral health care,” said Ryan Richard Ruff, M.P.H., Ph.D., associate professor in the Department of Epidemiology & Health Promotion at NYUCOD, co-principal investigator of CariedAway and the study’s first author.

Tamarinda Barry-Godín, D.D.S., M.P.H., was a study coauthor. z

Lawsuit Settlement continued from page 10

continued from page 8 -

Medicaid members; increased Medicaid reimbursement for private practice dentists serving the developmentally disabled (IDD) population; and increased reimbursement for ambulatory surgery dental services for the IDD population. NYSDA supports these proposals, but will continue to advocate for greater focus on oral health care as an essential patient service and for more funding to all programs that improve oral health care for underserved populations.

Changes to the Medicaid dental benefit program brought about by the May settlement are expected to result in long-term cost savings for New York State and its taxpayers by allowing Medicaid recipients to immediately address dental needs before they worsen and significantly impact overall health, requiring additional dental and/or medical attention. z

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Giant Pumpkins continued from page 9 -

ment options, the Great Midwest Get Together draws nearly 2 million visitors annually, making it the largest state fair by daily attendance. I finally checked this attraction off my bucket list this year.

While I, unfortunately, missed the llama costume contest (llamas dressed in costumes, not people dressed as llamas), I did have the pleasure of attending an informative lecture on how to grow a giant pumpkin. The topic seemed a bit dry, but I was lured in by the promise of free giant pumpkin seeds. The hour-long lecture covering soil pH, nutrient requirements, and the pros and cons of fungicide went by surprisingly quickly. The presenter, dressed in a pumpkin-patterned suit, was engaging, and his excitement was contagious. I had never before thought of myself as an award-winning pumpkin grower, but I was suddenly considering how I would get a 2,000-pound pumpkin over my fence.

This struck me as an excellent example of how much demeanor changes interactions. As dentists, we have a unique opportunity to inspire patients to achieve a greater level of health. For a lot of our patients, a visit to the dentist can seem like the worst thing in the world. An appointment can be met with ambivalence, much less enthusiasm. However, imagine what a difference we can make if we are able to impact how patients see the future of their dental health.

It becomes easy to get caught up in daily responsibilities and forget what an impact we can make. It is important to remember what becomes our everyday can change someone’s quality of life. If sharing your enthusiasm can shift the perspective on dentistry from necessity towards privilege for just one person, it will be worth it. So, spend a little more time thinking about the “why” of what we do and share that with your patients. If at first this feels as silly as wearing a pumpkin-patterned suit, persist, because even if it doesn’t connect with your patient, it might bring a little joy to your own life.

The other valuable lesson this giant-grower enthusiast was able to impart was the value of community. I now belong to an online community of giant growers. While I’m slowly coming to terms with the fact that I don’t have space for a garden of giant plants, I still enjoy the view from the sidelines. Record-breaking fruits are celebrated, and when a plant is lost to animal damage or cracks beyond regulation-accepted depth or length, kind words from fellow growers expressing sympathy flood in.

Much like dentistry, growing can be a lonely endeavor. Outside of competitions, growers often tend their gardens alone. A dentist in a solo practice is similarly alone in his or her world. While online communities for dentists abound, there is no substitute for in-person interaction. The dental society is an invaluable resource for achieving a sense of community. Take the opportunity to connect with dentists who truly care about the future of our profession.

I think it’s also important to remember to take breaks. You can’t eat, sleep or breathe dentistry day in and day out; sometimes, you need to branch out. If you have an available 900 square feet of soil, and a complete disregard for your water bill, growing giant pumpkins may be for you. But, even if it’s not, take some time to learn something new, because you might find valuable lessons where you least expect them. z

NEWS 14 1
Dr. Patrella is vice president, Nassau County Dental Society and chair of the society’s Ethics Council. Her article is reprinted, with permission, from the September-December 2022 Nassau County Dental Society Bulletin.

New York State Department continued from page 11 -

to transition from the classroom into the workforce. Individuals with training in public health, medicine, dentistry, nursing, pharmacology/pharmacy, allied health, social services, communications and information technology, logistics planning, education and emergency health programs are encouraged to apply.

When selected for the NYSPHC Program, fellows can invest in professional development opportunities, including the Public Health Essentials Certificate Program, which was created by Cornell University’s Master of Public Health Program. This innovative experiential learning course, taught by Cornell University professors, aims to equip learners from diverse professional and educational backgrounds with the tools and skills needed to excel in the field of public health. This benefit is provided to all NYSPHC Fellows at no cost.

The NYSPHC Program is also looking for volunteers to mentor fellows. Mentors serve as role models and provide support and guidance to Fellows. Mentors can be current public health professionals or individuals who have experience working in public health at the local, state or federal level. All individuals interested in serving as a mentor are encouraged to complete the Mentor Nomination Form available on the NYSPHC website.

For more information on which counties are recruiting for NYSPHC Fellows and to apply visit www.ny.gov/publichealthcorps.

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* When enlarging or reducing this logo, always make sure to select Scale Strokes & E ects o maintain the integrity of the gradients in the core graphic. Main Logo on White Background Vertical Logos on Reversed-out Main Logo on Charcoal Background (with drop shadow behind-right of core graphic) Main Logo on Carbon Fiber Background (with drop shadow behind-right of core graphic)